Neelima Vijayan, Padmanabhan Karthikeyan, Nirmal Coumare Venkataramanujam, Ramiya Ramachandran Kaipuzha and Davis Thomas Pulimoottil
OBJECTIVE. This study aimed to analyse the association of absolute eosinophil count (AEC), serum IgE and spirometry with co-morbid bronchial asthma in patients with allergic rhinitis.
MATERIAL AND METHODS. This study involved 50 patients with signs and symptoms of allergic rhinitis who underwent a clinical examination and various tests, including spirometry, and were followed up regularly. Patients found to have bronchial asthma or nasal polyposis were treated accordingly.
RESULTS. The study found the prevalence of bronchial asthma in patients with allergic rhinitis to be 58% and that the severity of bronchial asthma was reduced significantly, with lesser acute attacks and reduced hospitalizations with the effective treatment of allergic rhinitis (p=0.064).
CONCLUSION. This study showed that elevated AEC and serum IgE were significantly associated with co-existing allergic rhinitis and bronchial asthma and increased the chance of co-existence of these two pathologies. Spirometry is a useful tool for observing the response to treatment.
Padmanabhan Karthikeyan, Sneha Mary Joy, Davis Thomas Pulimootil and Neelima Vijayan
ENT surgeons frequently encounter a variety of neoplastic, non-neoplastic and inflammatory masses involving the nasal cavity, the paranasal sinuses or the nasopharynx. Among these, the angiomatous polyp or angiectatic nasal polyps are rare and account for 4-5% of all inflammatory nasal polyps. They have variable growth patterns and clinical features. In angiomatous nasal polyps, there is a prominent component of dilated capillary-type blood vessels. We present a review of the literature regarding the most important features of this pathology and an unusual case of a large angiomatous polyp arising from the maxillary sinus.
Congenital anosmia, isolated or as a symptom of Kallmann or Klinefelter syndrome, is a rare condition found in young patients and children. Anosmia is detected during childhood, being reported by the patient or by his/her family. Besides the clinical examination and olfactometric evaluation, imaging is mandatory for the olfactory pathways investigation. Multidisciplinary approach is needed for these patients in order to determine the etiology of the smell loss. In the current paper, we are presenting the case of an 11-year-old child diagnosed in our ENT Department with congenital anosmia.
Bogdan Mihail Cobzeanu, Dragos Octavian Palade, Andrei Rosu, Patricia Sonia Vonica, Cristian Martu, Luminita Radulescu, Daniela Carmen Rusu, Luiza Maria Cobzeanu and Mihail Dan Cobzeanu
The authors conduct a review of the etiopathogenesis, the main diagnostic methods and the treatment principles in cervico-facial pain. Pain in otorhinolaryngology is a multifactorial symptom, based on the rich innervation and vascularisation of the cephalic extremity. Pain can be of central or peripheral origin, acute and chronic. With the diversification of methods for exploring pain-generating lesions, different treatment protocols could also be achieved.
Codrut Sarafoleanu, Elena Patrascu, George Bacarna and Gabriela - Violeta Melinte
BACKGROUND. Unfortunately, tuberculosis is still being diagnosed among patients, independent of their age, gender, provenance or social category. The etiologic agent of tuberculosis is Mycobacterium tuberculosis, which is known to have a period of latency between the initial infection and the clinical manifestation. The most common localization is pulmonary, but it can affect, secondarily, other organs, especially in the ENT regions, mimicking other systemic diseases.
MATERIAL AND METHODS. We are presenting a case of a 51-year-old female patient, who was referred to our ENT Clinic with the suspicion of Behcet’s disease with rhinosinusal manifestations. She had a pulmonary assessment in another hospital, as she was known with left lung bronchiectasis, but the sputum samples were negative. The clinical otorhinolaryngologic examination together with the rheumato-logical assessment and the result of the nasal mucosa biopsy were suggestive for Behcet’s disease and the patient received 6 weeks of Prednisolone. The specific immunologic tests (cANCA, pANCA, HLA B51) were negative. The patient returned to our clinic after 2 months, accusing symptomatology reacutization with right otorrhea and bilateral hearing loss aggravation. Nasal and rhinopharyngeal mucosa biopsies were repeated and the anatomopathological result was specific for tuberculosis.
RESULTS. She was referred to the Pneumology Service where she received the diagnosis of pulmonary tuberculosis with rhinosinusal and otic manifestations. Currently, the patient is under tuberculostatic treatment.
CONCLUSION. Extrapulmonary tuberculosis symptoms might be confused with other systemic diseases with rhinosinusal manifestations. Thorough examination and multidisciplinary approach are mandatory in order to establish a correct diagnosis followed by an appropriate treatment.
Carmen Badea, Codrut Sarafoleanu and Andreea Marza
Rhinosinusal mucormycosis is a life-threatening disease caused by fungus of the order Mucorales, which commonly affects individuals with diabetes and those in immunocompromised states. It is the most common form of mucormycosis with a high mortality rate (50-80%). Treatment options include reversal of the underlying risk factors when it is possible, systemic antifungal medication and radical surgical debridement. Prognosis is reserved because of the high potential of invasiveness, so diagnosis and early treatment are essential.
Herein, we make a review about the most important features of this pathology and we report two cases of rhinosinusal mucormycosis with similar presentations who followed the same treatment protocol – extended surgical debridement of the necrotic tissue combined with systemic antifungal treatment (Amphotericin B). Complete recovery was achieved in one patient, whereas in the other one, due to late presentation, massive extension and incomplete surgical debridement, the disease was complicated with multiple organ dysfunction and cerebral stroke.
By presenting these cases, we would like to point out the importance of early diagnosis, appropriate medical and surgical therapy to obtain a significant survival rate in patients with this fatal disease.
Adriana Mocian, Eliza Russu, Reka Kaller and Adrian Mureșan
Chronic mesenteric artery disease has a much lower incidence than the acute one, but it raises the same problems in terms of patient survival. The long-term outcomes for open surgery are crucial for the right choice of a particular technique. We present the case of a 39-year-old female patient with a history of total nephrectomy, chronic kidney failure, and hypertension, who presented in the Emergency Department with abdominal pain with high intensity, for which she was admitted to the General Surgery Department. Abdominal computed tomography angiography was performed, which indicated the diagnosis of partial upper mesenteric artery stenosis. The patient underwent surgery, during which a retrograde aorto-mesenteric bypass with a Gore-Tex 5 mm diameter prosthesis was performed. In situations where the endovascular approach fails or has no indication (multiple incidence lesions from the origin of the superior mesenteric artery), open surgery is the indication in chronic mesenteric ischemia.
Evelin Szabó, Diana Opincariu, Zsolt Parajkó, Noémi Mitra, Theodora Benedek and Imre Benedek
Out-of-hospital cardiac arrest (OHCA) has a poor prognosis and is the most severe complication of any cardiac event. It is known from previous studies that the location of the culprit lesion in ST-segment elevation myocardial infarction (STEMI) patients with cardiac arrest may affect the post resuscitation survival rate. However, due to the low number of cases, the association between the localization of the culprit lesion within the coronary tree and the occurrence of cardiac arrest is not widely discussed, because resuscitated cardiac arrest patients are excluded from the vast majority of clinical trials. This is a prospective observational study that aims to develop a prediction model for OHCA in patients who present with STEMI, based on differences related to culprit lesion location. The primary objective of the study is to evaluate the differences related to the location of the culprit lesion in patients with STEMI who present OHCA versus patients without cardiac arrest.
Anca Chiriac, Cristina Birsan, Cristian Podoleanu and Simona Stolnicu
Introduction: An ingrown toenail is a serious medical problem that cannot be overlooked, and the decision of choosing between conservative versus surgical treatment may be difficult in daily practice.
Case series presentation: We present the cases of two young men with a long history of ingrown toenails, previously treated by complete nail avulsion, numerous topical applications of antibiotics, and 5% silver nitrate, successfully treated with caustic chemical agents, compared to a 19-year-old athlete with debilitating pain, intense inflammatory changes, infection, granulation tissue induced by skin penetration of lateral nail edge by an incurved toenail, in whom surgical treatment was needed.
Conclusion: Chemical matricectomy in the absence of any surgical intervention, along with patience allowing the nail to grow, could be an option that is easy to perform in case of ingrown nails. However, the selection of cases is important, taking into balance the benefit-risk ratio.
Ramiya Ramachandran Kaipuzha, Nirmal Coumare Venkataramanujam, Padmanabhan Karthikeyan and Davis Thomas Pulimoottil
OBJECTIVE. To study and compare the benefits of microdebrider-assisted endoscopic sinus surgery and conventional endoscopic sinus surgery in terms of subjective and objective improvement in symptoms of nasal polyposis.
MATERIAL AND METHODS. This study involved 60 patients with bilateral sinonasal polyposis scheduled to undergo Endoscopic Sinus Surgery. The patients were randomized into two groups: Group A -Conventional endoscopic sinus surgery and Group B -Microdebrider-assisted endoscopic sinus surgery.
RESULTS. There was a significant difference in the mean VAS at 3 months postoperatively in Group B, but no significant difference at 6 months postoperatively following either of the two methods. The mean time for surgery (p<0.01) and the mean intraoperative blood loss (p<0.01) were significantly lower in Group B.
CONCLUSION. A well-trained surgeon with proper anatomical knowledge, good instruments, hypotensive anaesthesia, minimal mucosal injury and regular proper follow-up will have similar postoperative results with both methods.